Pharmacy Department, Sibley Memorial Hospital - Johns Hopkins Medicine, Washington, DC, USA.
Maternal Fetal Medicine Sibley Memorial Hospital - Johns Hopkins Medicine, Baltimore, USA.
J Perinat Med. 2022 Jul 8;50(9):1218-1224. doi: 10.1515/jpm-2021-0558. Print 2022 Nov 25.
The 2019 American College of Obstetricians and Gynecologists (ACOG) guidelines update for the prevention of perinatal group B (GBS) infections stipulate that vancomycin should be reserved to treat penicillin-allergic women at high risk for anaphylaxis with documented GBS resistance to clindamycin. Protocols and policies were adapted at the community hospital to incorporate these new guidelines. The primary objective of this research was to evaluate institutional compliance to these guidelines and secondarily, clinical outcomes.
Clinical pharmacists, in collaboration with an obstetrician, performed this hospital-based study. All instances of intravenous (IV) vancomycin therapy in GBS-positive patients were assessed from 1/1/2018 through 1/1/2021 and compared to the 2010 and 2019 ACOG guidelines. Treatment was analyzed to determine the appropriateness of both indication for use and dosage regimen as co-primary endpoints. Secondary endpoints included renal monitoring parameters, suspected adverse reactions, and early onset GBS disease in newborns, specifically sepsis, meningitis, and/or pneumonia.
L&D admissions during the study period included 15,129 patients. All 30 L&D patients who received IV vancomycin for GBS prophylaxis were included in the study. This project demonstrated low compliance to the ACOG guidelines and identified previously unrecognized opportunities for improvement.
The low compliance observed in this study, with the exception of documenting GBS status, occurred in spite of hospital adoption of a GBS order set, an updated vancomycin protocol and targeted education of clinical pharmacists. Assessment of the causes of noncompliance identified several potential corrective actions, especially in ordering and monitoring vancomycin.
2019 年美国妇产科医师学会（ACOG）预防围产期 B 组（GBS）感染指南更新规定，万古霉素应保留用于治疗青霉素过敏且有 GBS 对克林霉素耐药史的高过敏风险妇女。社区医院对方案和政策进行了调整，以纳入这些新指南。本研究的主要目的是评估机构对这些指南的依从性，其次是评估临床结果。
临床药师与妇产科医生合作进行了这项基于医院的研究。从 2018 年 1 月 1 日至 2021 年 1 月 1 日，对所有 GBS 阳性患者的静脉（IV）万古霉素治疗情况进行评估，并与 2010 年和 2019 年 ACOG 指南进行比较。治疗分析旨在确定使用适应症和剂量方案的适当性作为主要终点。次要终点包括肾脏监测参数、疑似不良反应和新生儿早发性 GBS 疾病，特别是败血症、脑膜炎和/或肺炎。
研究期间 L&D 入院患者包括 15129 例。所有接受 IV 万古霉素预防 GBS 的 30 例 L&D 患者均纳入研究。尽管医院采用了 GBS 医嘱集、更新的万古霉素方案和临床药师的针对性教育，但本项目显示对 ACOG 指南的依从性较低，并发现了以前未被认识到的改进机会。
尽管医院采用了 GBS 医嘱集、更新的万古霉素方案和临床药师的针对性教育，但本研究观察到的低依从性，除了记录 GBS 状态外，还存在几种潜在的纠正措施，特别是在万古霉素的开具和监测方面。
